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i <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8810 • FAX 425�257•8857 • www.everettwa.orp <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />J001 North Broodway <br />PROJECT/+DDRESS <br />OEMC 916 Pocific Ave Evereft, W.1 9B201 <br />Owner Mail Address Cily State2ip <br />Tenanl Mall Address City State2ip <br />Radgers E/ecfric <br />Elec�rical Conlractor <br />ROD6EEC232PA <br />Sta�e Licensc Numbcr <br />� ���-07 <br />C 070 ��o � <br />O <br />Phone <br />0 <br />Phone <br />PO Box ll,ri2 Everett WA 9B206 425.252.2I07 <br />Mail hddress Cily Sla�elZip Phone <br />.S 35, A�O.OiO <br />CoMrecl Pnce oi Work <br />PEMC - Access Clinic Expansion Mourttn Jackson <br />Proposed Use of �uilding Contacl Person (Plan Review) <br />Descrlptiai o( Work lo �e Dnne Additian to the Existing PEMC Aceess Clinic <br />Demo, Distribution, Power, Lighting, Phanc/Data, LV Raceways Pafient Coll cf fire A/arm. <br />0 <br />NCT[� WIRING IN NON-DW[LLINGS IS R[QUIRED TO <br />B[ IN RACEbV�YS. MC OR AC CADLF. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hmeby certdy (hnf 1 bnve mad anA eenmmed fhis npphcnhon anA knnw Nw semo fo bo huo nnd <br />cormcf All provisrorrs o/ Inws nnd aUinances povaning fh�s fype oI work �vdl bo complofnd <br />whofher spunM1nd hwoin or not Tho gr�nfm9 0! n panrR Aoes nof p�esmnc fo give nufhonty fo <br />violale or cr+ncol Iho prov�siona ol nny ofhw slnfa or locnllnw mgulnlinp conslrucfion or (ho <br />perinrrnnnco ol conshucfion Tlml l nrrr nufhorrzed 6y Iho ownnr o! flris pmporty lo pedonn fho <br />�vn�k /nr �vhrch npplicntion is nradc nnA I cnrrrply wilh B�0 Slnle ConhFlc(ors Law iH 27 RCW nnd <br />29G 200 W�C <br />l <br />Jeffery Olsen <br />7.10.7 <br />FEE <br />$ 615. 00 <br />� <br />�/ ItnACrn I�.hrtric f n.. Inr. <br />( JJ I�Iqnldl'4.v{ulY�ni�n <br />Job: J096 <br />